Inside Health

Questions for Your Doctor

What to Ask About A.D.H.D.

By ALIYAH BARUCHIN

Confronting a new diagnosis can be frightening — and because research changes so often, confusing. Here are some questions you may not think to ask your doctor, along with notes on why they’re important.

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What’s the difference between your average high-energy kid and a child with attention-deficit hyperactivity disorder?

For decades, critics of A.D.H.D. have tried to characterize it as just a way to pathologize normal childhood behavior. It’s important to remember that A.D.H.D. is a biological, genetically based medical condition that can seriously impair children’s ability to succeed in school and in relationships with their family and peers. Your doctor can talk with you about the specific behaviors and degrees of impairment that differentiate children with A.D.H.D. from other kids.

Is there one medical test, like a brain scan, that diagnoses A.D.H.D.?

Because A.D.H.D. can’t be diagnosed by a single test, it’s important to be evaluated by a mental-health professional who is very familiar with A.D.H.D. That could be a child psychiatrist, a developmental pediatrician, a child neurologist or psychologist or even a general pediatrician. A thorough history is crucial to making an A.D.H.D. diagnosis. A health professional will screen for symptoms (using Diagnostic and Statistical Manual criteria for kids and other screening tools for adults) and will ask questions about the kinds of impairments you (or your child) are experiencing at home, at school, at work or with friends.

My child was just diagnosed with A.D.H.D., and it’s supposed to run in families. Should I be evaluated for it?

It’s important to learn about the genetics of A.D.H.D. because it is very strongly inherited, almost as strongly as the trait for height. Children are diagnosed much more often than adults; in fact, many adults are diagnosed only because their child’s diagnosis seems to describe them as well. Being diagnosed and treated as an adult can help you function better at home, at work and as a parent.

Our daughter’s pediatrician thinks she may have inattentive-type A.D.H.D. — A.D.H.D. without the “H”. Can you have A.D.H.D. without being hyperactive?

Because inattentive-type A.D.H.D. — A.D.H.D. without hyperactivity — is a more recently recognized diagnosis, many children described as dreamy or “spacey” were previously overlooked for A.D.H.D. The three major types of A.D.H.D. — hyperactive-impulsive, inattentive, and combined — can have very different symptoms and respond to different treatments. Most people think of the hyperactive-impulsive form — a child who can’t sit still or darts from one activity to the next — when they think of A.D.H.D. The combined form includes both hyperactivity and inattention.

Even today, some people continue to deny what four decades of solid research on A.D.H.D. have shown: that A.D.H.D. is biologically based and of genetic origin. Parenting doesn’t cause attention deficit, but it can make symptoms worse if done badly, or help if done well. Specific techniques can create organization and structure that are crucial in helping kids with A.D.H.D. function better, and studies show that children with A.D.H.D. fare better in homes with lower levels of conflict. Your doctor can talk with you about parenting tools that are key to helping your child.

How do stimulant medications work in A.D.H.D.? Isn’t Ritalin basically speed?

There are several schools of thought about stimulants, but 60 percent to 70 percent of people with A.D.H.D. who take stimulants benefit from them, which makes them an important part of treatment. These medications work by addressing the atypical need for stimulation in the A.D.H.D. brain, and in people for whom they work well, they sharply improve quality of life. They are not for everyone; ask your doctor who benefits most from stimulants, and what the side effects are.

What other kinds of treatments besides medication are available for children with A.D.H.D.?

Many parents are reluctant to give their children medication to treat A.D.H.D. Whether or not a child needs medication depends on what type of attention deficit they have and how severely it is affecting their daily school performance and social interactions. Your doctor can discuss other treatment options — like behavior modification programs, organizational skills training and lifestyle changes — that can be used either in conjunction with medication or on their own.

Is A.D.H.D. different in girls from in boys?

Many more males than females have A.D.H.D. — the ratio is about 3 to 1 — but A.D.H.D. definitely affects girls and women. Because girls with A.D.H.D. tend to be less disruptive than boys and more often have the inattentive type of the disorder, they have typically been diagnosed less often. Though not as visible as hyperactivity, inattention can cause severe impairments in school and at home.

At what age is it appropriate to tell a child that he’s been diagnosed with A.D.H.D.?

Many parents fear that their children will feel disabled or stigmatized if they know that they have been “diagnosed” with something. You may want to describe A.D.H.D. to your child not as an illness or problem but as a certain brain type that works in a particular way. Talk with your doctor about what children can understand about A.D.H.D. at various ages and what message will be most helpful to your child given his personality.

I had A.D.H.D. as a kid, but it was never diagnosed or treated back then, and I still survived. Why does my child with A.D.H.D. need treatment in order to get through it?

Many adults with A.D.H.D. who were never diagnosed or treated as children developed extensive coping mechanisms to overcome the often severe problems they encountered in school, at work and in relationships. But it’s important to remember that A.D.H.D. causes real and often substantial impairments, and that diagnosing and treating A.D.H.D., preferably as early as possible, can radically improve children’s lives.